Indoor Air Pollution and Respiratory Health

Impact of solid fuel use on asthma prognosis and consistent peak expiratory flow changes: Evidence from China

BACKGROUND

Exposure to solid fuels might result in substantial indoor air contamination that can detrimentally affect respiratory wellness. Yet the connection between use of such fuels and the incidence as well as the progression of asthma needs further clarification. This investigation endeavors to conduct an integrative cross-sectional and longitudinal study to examined the link between solid fuel utilization and asthma.

METHODS

Involving participants from the China Health and Retirement Longitudinal Study (CHARLS), this research scrutinized the impact of solid fuel exposure on asthma incidence, peak expiratory flow (PEF), and mortality in asthma patients. The study applied logistic and linear regression for the cross-sectional data, Cox proportional hazards models and linear mixed effects methods were utilized to gauge the impact on mortality and PEF among subjects with asthma.

RESULTS

Among the 12025 individuals surveyed, use of solid fuels was significantly associated to increased asthma risk and a decrease in PEF among the Chinese population (P < 0.001), with consistent trends noted across categories of age, gender, and smoking habits. The survival analysis demonstrated that, when contrasted with non-asthmatic individuals using cleaner fuel, the risk of all-cause mortality was 1.63 times higher (95 % CI = 1.33, 2.00, p < 0.001) in asthmatic individuals regularly using solid fuels. Mixed-effects model pointed to a statistically potential interaction between gender and the influence of solid fuels on long-term reduction in PEF in patients with milder asthma forms.

CONCLUSIONS

The research provided insights into the harmful effects of solid fuel dependence on asthma risk and outcomes, contributing novel evidence supporting this link. The results emphasize the necessity of curtailing solid fuel use to diminish potential health risks associated with asthma and to improve prognosis in affected individuals.

Fractional exhaled nitric oxide (FeNO) among school children in Java and Sumatra, Indonesia: associations with respiratory symptoms, house dust mite sensitization and the home environment

OBJECTIVE

To study associations between fractional exhaled nitric oxide (FeNO) and asthma, airway symptoms, sensitization to common allergens, outdoor pollution and home environment among 380 students in eight junior high schools in two areas in Indonesia.

METHODS

Data on health and home were collected by a face-to face interview before measuring FeNO and performing skin prick test against common allergens. Exploratory linear mixed and logistic regression models were employed.

RESULTS

Geometric mean of FeNO was 17.8 ppb (GSD 2.09) and 139 students (36.6%) had elevated FeNO (>20 ppb). In total, 107 students (28.2%) were sensitized to house dust mite (HDM) (Der p1 or Der f1), 4 (1.1%) to cat and 3 (0.8%) to mold (Cladosporium or Alternaria). Moreover, 20 students (5.3%) had diagnosed asthma, 38 (10.0%) had current wheeze, and 107 (28.2%) had current rhinitis. HDM sensitization, diagnosed asthma, current wheeze, and current rhinitis were associated with FeNO. In total, 281 students (73.9%) had mold or dampness, 232 (61.1%) had environmental tobacco smoke (ETS) and 43 (11.3%) had other odor at home. Indoor mold or dampness and other odor at home were associated with FeNO. ETS was negatively associated with FeNO.

CONCLUSION

HDM sensitization and elevated FeNO can be common among children in this part of Indonesia. The high prevalence of elevated FeNO indicate that undiagnosed childhood asthma is common. Dampness, mold and odor at home can be associated with increased FeNO while ETS can be associated with decreased FeNO.

Prevalence of indoor air pollutants from First Nation homes in North Central British Columbia, Canada

Poor indoor air quality poses significant health risks. This study addresses the gap in knowledge regarding the prevalence of indoor air pollutants in remote and rural First Nation communities in north-central British Columbia, Canada. Dust samples from 75 homes were collected and analysed for house dust mites, pet allergens, mould antigens, and bacterial endotoxins. Indoor air quality parameters, including carbon monoxide, carbon dioxide, particulate matter, temperature, and humidity, were measured. A detailed questionnaire on household characteristics and potential pollutant sources was administered. Homes exhibited exposure to multiple pollutants, with wood stove smoke identified as a primary source. Felis domesticus (cat allergen) and Canis familiaris (dog allergen) were prevalent, with detectable levels in 64% and 60% of homes, respectively. Bacterial endotoxins were present in all households. One-third of homes exceeded recommended thresholds for 3 or more pollutants. This study provides critical insights into the prevalence and magnitude of indoor air pollutants, contributing to a broader initiative to characterise respiratory health in First Nations communities. While many homes in First Nations communities had acceptable air quality, one-third of homes exceeded thresholds for 3 or more pollutants. The results can guide ongoing community efforts to address housing concerns and advocate for increased federal funding.

Pollution exposure in the first 3 months post transplant is associated with lower baseline FEV1 and higher CLAD risk

BACKGROUND

Exposure to air pollution post-lung transplant has been shown to decrease graft and patient survival. This study examines the impact of air pollution exposure in the first 3 months post-transplant on baseline (i.e., highest) forced expiratory volume in 1 second (FEV1) achieved and development of chronic lung allograft dysfunction (CLAD).

METHODS

Double-lung transplant recipients (n = 82) were prospectively enrolled for comprehensive indoor and personal environmental monitoring at 6- and 12-week post transplant and followed for >4 years. Associations between clinical and exposure variables were investigated using an exposomics approach followed by analysis with a Cox proportional hazards model. Multivariable analyses were used to examine the impact of air pollution on baseline % predicted FEV1 (defined as the average of the 2 highest values post transplant) and risk of CLAD.

RESULTS

Multivariable analysis revealed a significant inverse relationship between personal black carbon (BC) levels and baseline % FEV1. The multivariable model indicated that patients with higher-than-median exposure to BC (>350 ng/m3) attained a baseline % FEV1 that was 8.8% lower than those with lower-than-median BC exposure (p = 0.019). Cox proportional hazards model analysis revealed that patients with high personal BC exposure had a 2.4 times higher hazard risk for CLAD than patients with low BC exposure (p = 0.045).

CONCLUSIONS

Higher personal BC levels during the first 3 months post-transplant decrease baseline FEV1 and double the risk of CLAD. Strategies to reduce BC exposure early following a lung transplant may help improve lung function and long-term outcomes.

Association between acute exacerbation of chronic obstructive pulmonary disease and short-term exposure to ambient air pollutants in France

BACKGROUND

Ambient air pollution is recognized as a major risk factor for chronic obstructive pulmonary disease (COPD) which is the third leading cause of death worldwide. We examined whether variations in daily outdoor air pollutants levels were associated with excess hospital emergency room visits (ERV) for acute exacerbation of COPD (AECOPD).

METHODS

This two-center ecological cohort study was conducted in Amiens, France. We collected all consecutive ERV for AECOPD throughout 2017 and developed single pollutant models to assess the association between AECOPD and nitrogen dioxide (NO2), ozone (O3), or particulate matter (PM2.5 and PM10) levels, while adjusting for temperature, hygrometry, influenza circulation and pollen allergy risk. For a subgroup of patients, we also applied geographical modeling to analyze annual exposure to outdoor air pollutants.

RESULTS

We recorded 240 ERV among 168 COPD patients in 2017 and identified 9 peaks of ERV. There was a statistically significant positive correlation between the daily ERV for AECOPD and the daily average concentrations of PM2.5 (RR = 1.06 (95%CI = [1.00-1.11]), p = 0.049), but no correlation with NO2, O3 or PM10 (p = 0.073, p = 0.114 and p = 0.119, respectively). Our geographical modeling study revealed that long-term exposure to any of the four outdoor air pollutants was not associated with more frequent AECOPD.

CONCLUSION

Even though the pollution levels measured generally remained below or near the 2021 short-term air quality guidelines issued by the World Health Organization, significant aggregate-level associations were found between severe AECOPD leading to ERV and daily concentrations of PM2.5.

CLINICAL TRIAL REGISTRATION

NCT03079661.

A review of recent advances in metal-organic frameworks materials for zero-energy passive adsorption of chemical pollutants in indoor environments

Approximately 75-90 % of a person's lifetime is spent inside increasingly airtight buildings, where indoor pollutant levels typically exceed those outdoors. Poor indoor air quality can lead to allergies, respiratory diseases, and even cancer, and can also reduce the longevity of buildings. Passive adsorption materials play a crucial role in reducing indoor pollutants. This review highlights the latest advances in using Metal-organic Frameworks (MOFs) as passive adsorption materials for indoor pollutant capture and outlines the principles for developing high-performance adsorbents. It provides a comparative analysis of the development and performance of MOFs and composite adsorbent materials, highlighting their respective advantages and limitations in indoor pollutant adsorption technology. The article proposes strategies to address these challenges and offers a comprehensive review of current practical adsorption devices. Finally, aiming to advance commercialization of MOFs, the anticipated development of indoor pollutant adsorption technology is discussed in this paper.

Household fuel use, smoking and prevalence of self-reported allergic rhinitis in university students in Palestine: a cross-sectional study

Purpose

In Palestine, few studies investigated the prevalence of allergies and the factors associated with their occurrence. An online survey was conducted on health complex University students in Jerusalem to determine the prevalence of allergy rhinitis (AR) and its relationship with indoor environmental exposures.

Methods

This study employed a modified online Google form of the Global Asthma Network's Adult Questionnaire. The data were reported as frequency and percentage. The chi-square test of independence was performed to investigate the association between AR diagnosis and other factors. Multivariable models were used to identify the independent risk factors for AR after adjusting for potential confounders.

Results

Data was collected from a total of 819 participants. The mean age of the participants was 20 ± 2 years and 78.1% (n = 640) were females. The AR diagnostic rate was 10.3%. In addition, having asthma and eczema were found to be substantially associated with AR. Additionally, a family history of AR and other allergens were major predictors of AR. The findings revealed that utilizing animal dung for heating increased the likelihood of AR fourfold (AOR = 4.870, p-value = 0.004), whereas e-cigarette vaping increased the possibility of AR by 2.5 times. However, using natural gas for cooking was not significantly associated with AR, and participant age was only slightly associated with AR diagnosis.

Conclusions

Our study found that the AR prevalence rate is low when compared to the same population in other countries. Genetics, biomass fuel consumption, and e-smoking are all significant risk factors for AR in Palestine. An awareness campaign must be developed to educate university students and the general public about the risks of smoking, indoor air pollution, respiratory disorders, and AR. Longitudinal research is required to discover whether these associations are only transient.

Indoor air pollution and airway health

Because of the disproportionate amount of time that people spend indoors and the complexities of air pollutant exposures found there, indoor air pollution is a growing concern for airway health. Both infiltration of outdoor air pollution into the indoor space and indoor sources (such as smoke from tobacco products, cooking or heating practices and combustion of associated fuels, and household materials) contribute to unique exposure mixtures. Although there is substantial literature on the chemistry of indoor air pollution, research focused on health effects is only beginning to emerge and remains an important area of need to protect public health. We provide a review of emerging literature spanning the past 3 years and relating indoor air exposures to airway health, with a specific focus on the impact of either individual pollutant exposures or common combustion sources on the lower airways. Factors defining susceptibility and/or vulnerability are reviewed with consideration for priority populations and modifiable risk factors that may be targeted to advance health equity.

Pedestrian flow-environmental pollutants interactions and health risks to residents in high-occupancy public areas of apartment buildings

The current interaction of pedestrian flow and environmental pollutants in high-occupancy public areas of apartment and the risks of residents being exposed to environmental pollutants are issues that are often overlooked but urgently need to be addressed. In this study, we provide a comprehensive of pedestrian flow-environmental pollutants interactions and health risks to residents in first-floor public areas of apartment with high-occupancy. The main findings indicate that under closed management conditions, there is a significant increase in TVOC and noise levels during the peak periods of nighttime pedestrian flow. In the correlation analysis, the significant impact of time granularity selection in clarifying the correlation between pedestrian flow and environmental pollutants has been highlighted, with larger time granularities generally showing stronger correlations, while finer time granularities may help identify specific risks in areas directly connected to the external environment. There is a significant correlation exists between pedestrian flow and environmental pollutants (TVOC, ozone, and noise), with higher concentrations of these pollutants observed during peak pedestrian flow periods, thereby increasing the risk of residents being exposed to adverse environmental conditions. To mitigate the risks associated with TVOC pollution and noise exposure, it is crucial to maintain proper ventilation, avoid conducting cleaning or maintenance activities during peak hours, and implement noise-reducing measures, such as distancing noise sources from residential areas or installing soundproofing barriers. Additionally, the study identifies total volatile organic compounds originating from property maintenance activities and clarifies their dispersion patterns, emphasizing the importance of developing robust, standardized maintenance protocols for indoor environmental quality assurance. This research can improve the environmental sustainability of apartment buildings and provide a theoretical basis for the development of environmental health strategies for high-occupancy public areas of apartment buildings.

Cleaning indoor air-what works for respiratory health: An updated literature review and recommendations

Indoor air pollution is a growing public health concern globally and is associated with increased respiratory symptoms and morbidity. Individuals spend most of their time indoors, and pollutant-related health effects are often driven by the indoor environment. Understanding effective interventions to improve indoor air quality and their impact on respiratory outcomes is key to decreasing the burden of air pollution for high-risk populations across the life-span. This review applies a hierarchy of interventions framework specific to respiratory health effects and focuses on recent studies of interventions to improve indoor air quality among high-risk populations with chronic respiratory disease published in the past 3 years. While policy and source control interventions are likely the most effective and equitable approaches to improve indoor air quality and benefit population health, these were less extensively investigated. Engineering interventions, such as air cleaner interventions, were the most widely studied. Several studies, including those focused on asthma and chronic obstructive pulmonary disease, demonstrated improvement in symptoms and medication receipt with interventions in both home- and school-based settings. Combined multilevel interventions with engineering and behavioral interventions led to improved respiratory outcomes in some, but not all, studies. Placing the recent work in the context of the broader literature, we identify gaps in research. Further research is needed to understand intervention effectiveness over time and an increased focus on policy and source control interventions that can mitigate risk in vulnerable populations.

Air pollution, dysbiosis and diseases: pneumonia, asthma, COPD, lung cancer and irritable bowel syndrome

With substantial effects on human health, air pollution has become a major global concern. Air pollution has been linked to numerous gastrointestinal and respiratory diseases with increasing mortalities. The gut and respiratory dysbiosis brought about by air pollution has recently received much attention. This review attempts to provide an overview of the types of air pollutants, their sources, their impact on the respiratory and gut dysbiotic patterns and their correlation with five major diseases including pneumonia, asthma, COPD, lung cancer and irritable bowel syndrome. Deeper insights into the links between pollutants, dysbiosis and disease may pave the way for novel diagnostic biomarkers for prognosis and early detection of these diseases, as well as ways to ease the disease burden.

Transforming air pollution management in India with AI and machine learning technologies

A comprehensive approach is essential in India's ongoing battle against air pollution, combining technological advancements, regulatory reinforcement, and widespread societal engagement. Bridging technological gaps involves deploying sophisticated pollution control technologies and addressing the rural-urban disparity through innovative solutions. The review found that integrating Artificial Intelligence and Machine Learning (AI&ML) in air quality forecasting demonstrates promising results with a remarkable model efficiency. In this study, initially, we compute the PM2.5 concentration over India using a surface mass concentration of 5 key aerosols such as black carbon (BC), dust (DU), organic carbon (OC), sea salt (SS) and sulphates (SU), respectively. The study identifies several regions highly vulnerable to PM2.5 pollution due to specific sources. The Indo-Gangetic Plains are notably impacted by high concentrations of BC, OC, and SU resulting from anthropogenic activities. Western India experiences higher DU concentrations due to its proximity to the Sahara Desert. Additionally, certain areas in northeast India show significant contributions of OC from biogenic activities. Moreover, an AI&ML model based on convolutional autoencoder architecture underwent rigorous training, testing, and validation to forecast PM2.5 concentrations across India. The results reveal its exceptional precision in PM2.5 prediction, as demonstrated by model evaluation metrics, including a Structural Similarity Index exceeding 0.60, Peak Signal-to-Noise Ratio ranging from 28-30 dB and Mean Square Error below 10 μg/m3. However, regulatory challenges persist, necessitating robust frameworks and consistent enforcement mechanisms, as evidenced by the complexities in predicting PM2.5 concentrations. Implementing tailored regional pollution control strategies, integrating AI&ML technologies, strengthening regulatory frameworks, promoting sustainable practices, and encouraging international collaboration are essential policy measures to mitigate air pollution in India.

Prevalence and Associated Factors of Chronic Respiratory Symptoms among Street Sweepers in Bangkok, Thailand: A Cross-sectional Study

Background

Chronic respiratory diseases are becoming a more prominent cause of morbidity and mortality worldwide. Street sweepers are commonly found in low- and middle-income countries. This job involves outdoor work that exposes workers to various health hazards and air pollution, particularly affecting respiratory health. There is still limited research focusing specifically on street sweepers. The study aims to examine the prevalence of chronic respiratory symptoms and the associated factors in street sweepers in Bangkok, Thailand.

Materials and Methods

We undertook a cross-sectional survey between February and April 2023. A multi-stage sampling technique was employed, stratifying the sample according to district locations within Bangkok, Thailand. Data were collected through a questionnaire assessing demographic characteristics, occupational and environmental factors, and respiratory symptoms using a modified version of the Medical Research Council questionnaire. Data analysis included bivariate analysis and multiple logistic regression.

Results

The response rate was 98.0% (n = 341). The prevalence of chronic respiratory symptoms among street sweepers in Bangkok, Thailand, with at least one respiratory symptom was reported by 33.7% of the participants, specifically cough (22%), phlegm (20.2%), dyspnea (17.6%), and wheeze (7.0%). The average age of the sample group was 43.2 years, with a majority being female (85.9%). Among the participants, 88.3% were non-smokers, while 37.2% reported exposure to secondhand smoke. All participants reported the use of respiratory protective equipment, with face masks used at 78.9%. 7.3% of the participants lived near sources of pollution, and 12.0% were involved in household pollution activities. An average annual air quality index in the workplace area was categorized as 'good' at 57.8%. Multiple logistic regression analysis revealed significant associations of chronic respiratory symptoms with the following factors: exposure to secondhand smoke [odds ratio (OR) =2.3, 95% confidence interval (CI) 1.3-4.2] and household activities (OR = 3.0, 95% CI 1.3-6.6).

Conclusion

Exposure to secondhand smoke and indoor air pollutants in household environments are significant factors associated with the symptoms. Raising awareness about secondhand smoke hazards in household and environmental settings and promoting self-care practices related to various activities with potential exposure to indoor air pollution is crucial.

NPCC4: Climate change and New York City's health risk

This chapter of the New York City Panel on Climate Change 4 (NPCC4) report considers climate health risks, vulnerabilities, and resilience strategies in New York City's unique urban context. It updates evidence since the last health assessment in 2015 as part of NPCC2 and addresses climate health risks and vulnerabilities that have emerged as especially salient to NYC since 2015. Climate health risks from heat and flooding are emphasized. In addition, other climate-sensitive exposures harmful to human health are considered, including outdoor and indoor air pollution, including aeroallergens; insect vectors of human illness; waterborne infectious and chemical contaminants; and compounding of climate health risks with other public health emergencies, such as the COVID-19 pandemic. Evidence-informed strategies for reducing future climate risks to health are considered.

A High Efficiency, Low Resistance Antibacterial Filter Formed by Dopamine-Mediated In Situ Deposition of Silver onto Glass Fibers

The coating of filter media with silver is typically achieved by chemical deposition and aerosol processes. Whilst useful, such approaches struggle to provide uniform coating and are prone to blockage. To address these issues, an in situ method for coating glass fibers is presented via the dopamine-mediated electroless metallization method, yielding filters with low air resistance and excellent antibacterial performance. It is found that the filtration efficiency of the filters is between 94 and 97% and much higher than that of silver-coated filters produced using conventional dipping methods (85%). Additionally, measured pressure drops ranged between 100 and 150 Pa, which are lower than those associated with dipped filters (171.1 Pa). Survival rates of Escherichia coli and Bacillus subtilis bacteria exposed to the filters decreased to 0 and 15.7%±1.49, respectively after 2 h, with no bacteria surviving after 6 h. In contrast, survival rates of E. coli and B. subtilis bacteria on the uncoated filters are 92.5% and 89.5% after 6 h. Taken together, these results confirm that the in situ deposition of silver onto fiber surfaces effectively reduces pore clogging, yielding low air resistance filters that can be applied for microbial filtration and inhibition in a range of environments.

Risk assessment of unclean cooking energy usage from the perspective of subjective wellbeing: The mediating role of perceived physical and mental health

Although outdoor air pollution has been associated with adverse health outcomes and decreased subjective welfare, there has been a lack of research investigating the potential risks associated with indoor unclean cooking energy usage from the perspective of subjective wellbeing. This paper systematically assesses the risks of unclean cooking fuel usage from the novel perspective of subjective welfare and examines the mediating role of perceived physical and mental health applying a large-scale nationally representative dataset. Analytical results demonstrate that the usage of unclean cooking energy has significantly negative impacts on subjective wellbeing, and this finding has been confirmed through various robustness tests. The mechanism behind this impact is that unclean cooking fuel usage reduces people's perceived physical and mental health status, which in turn decreases their subjective wellness. Furthermore, the negative consequences of using unclean cooking energy on subjective wellbeing are particularly pronounced among certain demographic groups, including older, lower educated, married individuals as well as those with lower economic status, uncovered by medical insurance and having less social capital. Findings of this study highlight the risks linked to unclean cooking energy usage, as evidenced in the negative impact on perceived health and subjective wellbeing. In light of the increasing focus on improving indoor environment as well as enhancing people's health and wellbeing, results of this paper emphasize the significance of promoting access to cleaner and healthier energy.

Management of Chronic Obstructive Pulmonary Disease: Constraints in Patient Pathway and Mitigation Strategies

Introduction

Respiratory diseases, ranking the third in Portugal, contribute significantly to illness and mortality. Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death globally. Identifying high-risk individuals and implementing early treatment is crucial due to the variability of COPD symptoms and exacerbations. This study aimed to identify effective strategies for preventing exacerbations and complications.

Methods

A Delphi involving 15 experts was performed. Experts included physicians, nurses, health managers, policymakers, public health experts, and patient organizations. Consensus was achieved at 73.3% for each strategy using a scale ranging from "agree" to "disagree." Three rounds were conducted to address six questions related to early diagnosis and patient follow-up. Challenges faced by the Portuguese Health System in managing COPD, obstacles in COPD exacerbation diagnosis and management, and effective strategies to overcome barriers were identified in the first round. The second and third rounds involved analyzing the gathered information and voting on each indicator to achieve consensus, respectively. Indicators were categorized into constraints and barriers, and strategies for reducing COPD exacerbations and disease burden.

Results

Out of a total of 134 valid indicators generated, 108 achieved consensus. Among the indicators agreed upon by experts, 18 pertained to barriers, challenges, and constraints, while 90 focused on action strategies for COPD. Among the strategies formulated, 25 consensus indicators target prevention strategies, 24 consensus indicators aim to enhance COPD referrals, and 41 consensus indicators focus on mitigating COPD exacerbations and reducing the overall disease burden.

Discussion/Conclusion

This study emphasizes the need for integrated investment in respiratory healthcare and recognition of the impact of COPD on patients, healthcare systems, and economies. Prevention and appropriate treatment of exacerbations are crucial for effective COPD management and reducing associated morbidity and mortality. Experts highlight the importance of improving coordination between different levels of care, integrating information systems, and decentralizing hospital responsibilities. The COVID-19 pandemic has further emphasized the importance of individual and collective respiratory health, necessitating investment in health promotion and COPD awareness.

Population modifiable risk factors associated with neonatal mortality in 35 sub-Saharan Africa countries: analysis of data from demographic and health surveys

Background

Sub-Saharan Africa (SSA) has the highest burden of neonatal mortality in the world. Identifying the most critical modifiable risk factors is imperative for reducing neonatal mortality rates. This study is the first to calculate population-attributable fractions (PAFs) for modifiable risk factors of neonatal mortality in SSA.

Methods

We analysed the most recent Demographic and Health Surveys data sets from 35 SSA countries conducted between 2010 and 2022. Generalized linear latent and mixed models were used to estimate odds ratios (ORs) along with 95% confidence intervals (CIs). PAFs adjusted for communality were calculated using ORs and prevalence estimates for key modifiable risk factors. Subregional analyses were conducted to examine variations in modifiable risk factors for neonatal mortality across Central, Eastern, Southern, and Western SSA regions.

Findings

In this study, we included 255,891 live births in the five years before the survey. The highest PAFs of neonatal mortality among singleton children were attributed to delayed initiation of breastfeeding (>1 h after birth: PAF = 23.88%; 95% CI: 15.91, 24.86), uncleaned cooking fuel (PAF = 5.27%; 95% CI: 1.41, 8.73), mother's lacking formal education (PAF = 4.34%; 95% CI: 1.15, 6.31), mother's lacking tetanus vaccination (PAF = 3.54%; 95% CI: 1.55, 4.92), and infrequent antenatal care (ANC) visits (PAF = 2.45; 95% CI: 0.76, 3.63). Together, these five modifiable risk factors were associated with 39.49% (95% CI: 21.13, 48.44) of neonatal deaths among singleton children in SSA. Our subregional analyses revealed some variations in modifiable risk factors for neonatal mortality. Notably, delayed initiation of breastfeeding consistently contributed to the highest PAFs of neonatal mortality across all four regions of SSA: Central, Eastern, Southern, and Western SSA.

Interpretation

The PAF estimates in the present study indicate that a considerable proportion of neonatal deaths in SSA are preventable. We identified five modifiable risk factors that accounted for approximately 40% of neonatal deaths in SSA. The findings have policy implications.

Funding

None.

A multi-environmental source approach to explore associations between metals exposure and olfactory identification among school-age children residing in northern Italy

BACKGROUND

Metal exposures can adversely impact olfactory function. Few studies have examined this association in children. Further, metal exposure occurs as a mixture, yet previous studies of metal-associated olfactory dysfunction only examined individual metals. Preventing olfactory dysfunctions can improve quality of life and prevent neurodegenerative diseases with long-term health implications.

OBJECTIVE

We aimed to test the association between exposure to a mixture of 12 metals measured in environmental sources and olfactory function among children and adolescents residing in the industrialized province of Brescia, Italy.

METHODS

We enrolled 130 children between 6 and 13 years old (51.5% females) and used the "Sniffin' Sticks" test to measure olfactory performance in identifying smells. We used a portable X-ray fluorescence instrument to determine concentrations of metals (arsenic (As), calcium, cadmium (Cd), chromium, copper, iron, manganese, lead (Pb), antimony, titanium, vanadium and zinc) in outdoor and indoor deposited dust and soil samples collected from participants' households. We used an extension of weighted quantile sum (WQS) regression to test the association between exposure to metal mixtures in multiple environmental media and olfactory function adjusting for age, sex, socio-economic status, intelligence quotient and parents' smoking status.

RESULTS

A higher multi-source mixture was significantly associated with a reduced Sniffin' Sticks identification score (β = -0.228; 95% CI -0.433, -0.020). Indoor dust concentrations of Pb, Cd and As provided the strongest contributions to this association (13.8%, 13.3% and 10.1%, respectively). The metal mixture in indoor dust contributed more (for 8 metals out of 12) to the association between metals and olfactory function compared to soil or outdoor dust.

IMPACT STATEMENT

Among a mixture of 12 metals measured in three different environmental sources (soil, outdoor and indoor dust), we identified Pb, Cd and As measured in indoor dust as the main contributors to reduced olfactory function in children and adolescents residing in an industrialized area. Exposure to indoor pollution can be effectively reduced through individual and public health interventions allowing to prevent the deterioration of olfactory functions. Moreover, the identification of the factors that can deteriorate olfactory functions can be a helpful instrument to improve quality of life and prevent neurodegenerative diseases as long-term health implications.

Exploring the Relationship Between Bakhour Use and Respiratory Health: A Cross-Sectional Study in the Jazan Region, Saudi Arabia

Background

Despite deep cultural traditions, incense burning significantly impacts respiratory health. Effects of Arabian bakhour remain unknown in Saudi Arabia's Jazan region with prevalent use. This cross-sectional study addresses this gap by investigating bakhour exposure and respiratory diseases.

Methods

This was descriptive cross-sectional study conducted in Jazan area, Saudi Arabia, from October 2023 to March 2024. A total of 1612 participants age more than 18 years, both gender and resident of Jazan Area were included. Those aged less than 18 years were excluded. SPSS v 26 was used for data analysis.

Results

The sample (n=1612) had a mean age of 29±11 years and was 63% female. Bakhour use was nearly universal (98%), especially using coal (73%). Higher bakhour frequency significantly associated with increased cough (p<0.01) and dyspnea (p<0.01). Certain bakhour types linked to greater allergic rhinitis prevalence (p<0.01). Regression analysis revealed cough during bakhour use worsened respiratory health (increased respiratory score) by 3.89 times (95% CI 1.13-6.64; p=0.006) while dyspnea increased the score by 7.48 times (95% CI 4.70-10.25; p<0.001).

Conclusion

This study provides valuable insights into the association between Bakhour use and respiratory health in the Jazan region. The findings emphasize the need for further research and public health interventions to mitigate potential respiratory risks associated with Bakhour use.

Effectiveness of Asthma Home Management Manual and Low-Cost Air Filter on Quality of Life Among Asthma Adults: A 3-Arm Randomized Controlled Trial

Background

Asthma affects the quality of life (QoL) of millions of people worldwide. Effective control is paramount to a decline in prevalence and severity. To address this, we aimed to investigate the effectiveness of an asthma home management manual and low-cost air filter in improving resource-limited settings.

Patients and Methods

This randomized controlled trial was conducted between March to July 2022. The participants were 18-55 years old outpatient with asthmatic patients. A total of 114 participants were recruited and randomly assigned to three groups: home management only, home management and air filtering, and control. Validated measurement tools were applied, and the Wilcoxon test was used to evaluate changes in QoL.

Results

Asthma burden was found in at least one-third of participants in each group. At baseline, there was no difference in mAQLQ scores among participants in all group allocations (p-value > 0.05), and the air filter group had an increase in the total mAQLQ score (p-value = 0.044) and post-intervention activity quality of life (p-value = 0.002). The environmental quality of life increased post-intervention (p-value = 0.004) and remained higher after four weeks of follow-up compared to baseline (p-value = 0.041) in the home management group participants.

Conclusion

The findings indicate that the enforcement of a home management manual and the application of low-cost filters in air circulation systems offer advantages in improving the quality of life of patients with moderate and mild asthma.

The impact of formaldehyde exposure on lung inflammatory disorders: Insights into asthma, bronchitis, and pulmonary fibrosis

Lung inflammatory disorders are a major global health burden, impacting millions of people and raising rates of morbidity and death across many demographic groups. An industrial chemical and common environmental contaminant, formaldehyde (FA) presents serious health concerns to the respiratory system, including the onset and aggravation of lung inflammatory disorders. Epidemiological studies have shown significant associations between FA exposure levels and the incidence and severity of several respiratory diseases. FA causes inflammation in the respiratory tract via immunological activation, oxidative stress, and airway remodelling, aggravating pre-existing pulmonary inflammation and compromising lung function. Additionally, FA functions as a respiratory sensitizer, causing allergic responses and hypersensitivity pneumonitis in sensitive people. Understanding the complicated processes behind formaldehyde-induced lung inflammation is critical for directing targeted strategies aimed at minimizing environmental exposures and alleviating the burden of formaldehyde-related lung illnesses on global respiratory health. This abstract explores the intricate relationship between FA exposure and lung inflammatory diseases, including asthma, bronchitis, allergic inflammation, lung injury and pulmonary fibrosis.

Preparation, Air Filtration Performance of a Fluorinated Polyimide/Polyacrylonitrile Nanofibrous Membrane by Electrospinning

This paper reports the successful fabrication of a new nanofibrous membrane, F-PI/PAN, through electrospinning of polyacrylonitrile (PAN) and fluorinated polyimide (F-PI). The nanofibrous membrane exhibits comprehensive properties for high-temperature filtration and robust PM2.5 (particulate matter with an aerodynamic equivalent diameter of 2.5 microns or less) removal. The introduction of F enhances the hydrophobicity of the PI. The relationship between the hydrophobic performance and the filtration performance of particles is investigated. The chemical group of the composite membrane was demonstrated using FITR, while the surface morphology was investigated using field emission scanning electron microscopy. The TGA results indicated good thermal stability at 300 °C. Various ratios of F-PI membranes were prepared to characterize the change in properties, with the optimal mass ratio of F-PI being 20 wt%. As the proportion of F-PI increases, its mechanical and filtration efficiency properties and hydrophobicity become stronger. The contact angle reaches its maximum of 128 ± 5.2° when PAN:F-PI = 6:4. Meanwhile, when PAN:F-PI = 8:2, the filtration efficiency reaches 99.4 ± 0.3%, and the elongation at break can reach 76%. The fracture strength can also reach 7.1 MPa, 1.63 times that of the pure PAN membrane.

The effect of clean cooking on the social participation of middle-aged and older adults in China: A prospective cohort study

BACKGROUND

Indoor air pollution stemming from the use of solid fuels, such as biomass and coal, is a significant public health concern, especially in developing countries. Understanding the connection between indoor air quality and social participation is essential for crafting effective interventions and enhancing the well-being of these populations. This study aims to investigate the influence of indoor air pollution on social participation among middle-aged and olderly individuals in China.

METHODS

This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), encompassing 17,711 samples, to investigate the link between cooking fuel type and social participation. Survival analysis Cox regression was used, complemented by logistic regression for supplementary analyses.

FINDINGS

Upon accounting for confounding factors, the analysis revealed that individuals who consistently used clean fuels and those who switched to clean fuels exhibited a significantly higher likelihood of increased social participation compared to those using solid fuels. The hazard ratios were 1.31 (95 % CI: 1.19-1.44) and 1.39 (95 % CI: 1.28-1.51), respectively. These findings remained consistent across various regression models and showed no signs of population heterogeneity. Furthermore, this study found that in the investigation of mediating effects, chronic disease did not demonstrate any mediating effect on social participation. However, the mediating effects of depression level and IADL (Instrumental Activities of Daily Living) were significant, accounting for 1.82 % and 7.35 % of the impact of clean cooking on social participation, respectively.

INTERPRETATION

This study provides compelling evidence that adopting clean cooking practices positively influences social participation among middle-aged and older individuals in China. We recommend that governments, communities, and individuals prioritize measures to enhance indoor air quality.

Indoor air pollution is associated with respiratory symptoms in children in urban Vietnam

Exposure to indoor air pollution (IAP) is a leading environmental risk for respiratory diseases. We investigated the relationship between respiratory symptoms and polluting indoor activities such as smoking, cooking and contact with pets among children in Ho Chi Minh City (HCMC), Vietnam. A cross-sectional survey applied a multistage sampling method in 24 randomly selected secondary schools across the city. Approximately 15,000 students completed self-administrated questionnaires on risk factors and respiratory health outcomes within the preceding 12 months. Data were analyzed using a multivariable logistic regression model with robust standard errors. Wheeze was the most common respiratory symptom (39.5 %) reported, followed by sneezing and runny nose (28.3 %). A small percentage of students self-reported asthma (8.6 %). Approximately 56 % of participants lived with family members who smoked. A positive association between exposure to indoor secondhand smoke and respiratory symptoms was observed, with adjusted odds ratios (aOR) of 1.41 (95 % CI: 1.25-1.60, p < 0.001) for wheezing and 1.64 (95 % CI: 1.43-1.87, p < 0.001) for sneezing and runny nose, respectively. Using an open stove fuelled by coal, wood, or kerosene for cooking was associated with wheeze (aOR: 1.36, CI 95 %: 1.10-1.68, p = 0.01) and sneezing and runny nose (aOR: 1.36, CI 95 %: 1.09-1.69, p = 0.01). In the present study, IAP was associated with adverse health outcomes, as evidenced by an increase in respiratory symptoms reported within the previous 12 months.

Avoidance of Inhaled Pollutants and Irritants in Asthma from a Salutogenic Perspective

Much is known about the role of aeroallergens in asthma, but little is described about the damage caused by inhaled pollutants and irritants to the respiratory epithelium. In this context, the most frequent pollutants and irritants inhaled in the home environment were identified, describing the possible repercussions that may occur in the respiratory tract of the pediatric population with asthma and highlighting the role of the caregiver in environmental control through a salutogenic perspective. Searches were carried out in the MEDLINE/PubMed, Web of Science, Lilacs and Scopus databases for articles considered relevant for the theoretical foundation of this integrative review, in which interactions between exposure to pollutants and inhaled irritants and lung involvement. Articles published in the last 10 years that used the following descriptors were considered: air pollution; tobacco; particulate matter; disinfectants; hydrocarbons, fluorinated; odorants; chloramines; pesticide; asthma; and beyond Antonovsky's sense of coherence. Exposure to smoke and some substances found in cleaning products, such as benzalkonium chloride, ethylenediaminetetraacetic acid and monoethanolamine, offer potential risks for sensitization and exacerbation of asthma. The vast majority of the seven main inhaled products investigated provoke irritative inflammatory reactions and oxidative imbalance in the respiratory epithelium. In turn, the caregiver's role is essential in health promotion and the clinical control of paediatric asthma. From a salutogenic point of view, pollutants and irritants inhaled at home should be carefully investigated in the clinical history so that strategies to remove or reduce exposures can be used by caregivers of children and adolescents with asthma.

Construction of CdS@g-C3N4 heterojunction photocatalyst for highly efficient degradation of gaseous toluene

Exploring efficient photocatalysts for the degradation of VOCs under visible light is a challenge. CdS@g-C3N4 heterojunction photocatalytic materials were developed in this study using a microwave-assisted sol-gel process. CdS@g-C3N4(0.2) photocatalyzed the maximum degradation of gaseous toluene under visible light irradiation, and the time required to achieve the same degradation rate was reduced by 270 min when compared to pure CdS. The morphological characterization, photoelectric property analysis, and DFT calculations all verified that the CdS nanoparticles were uniformly disseminated on the surface of g-C3N4, and that the interfaces were closely contacted to form a heterojunction interface with a built-in field. This enhances charge transfer from CdS to g-C3N4 while successfully decreasing electron-hole pair recombination caused by light. Furthermore, the energy band structure was altered to absorb longer wavelengths of light and extend the absorption spectral range, improving the photocatalytic material's efficacy for broad-spectrum light such as sunshine. This paper proposes methods for predicting and optimizing the surface structure of catalysts, as well as developing high-performance multi-heterojunction photocatalysts for the degradation of indoor VOCs.

Participant-collected household dust for assessing microorganisms and semi-volatile organic compounds in urban homes

Dust samples collected by researchers and study participants from 43 U.S. urban homes were analyzed and compared to evaluate the feasibility of using participant-collected samples to assess indoor environmental exposures. The microbial and chemical composition of participant-collected (and shipped) samples were compared to researcher-collected samples from the same household, using dust recovered from each home's heating, ventilation, and air conditioning (HVAC) filter. The bacterial and fungal communities present in all dust samples were determined via MiSeq 16S and ITS sequencing, and the concentrations of 27 semi-volatile organic compounds (7 orthophosphates, 6 phthalates, and 14 brominated flame retardants) were determined via GC-MS. Self-report data on the home environment was collected via an online survey of study participants. While the researcher-collected samples (RCS) yielded greater mass than the participant-collected samples (PCS), the alpha and beta diversities of the bacterial and fungal communities recovered in the RCS and PCS were not significantly different, indicating that PCS is a viable option for indoor microbiome studies of residential homes. The microbial communities recovered in both cases reflected the dominance of human-associated bacterial taxa and outdoor-associated fungal taxa with similar pathogen-associated taxa present in each sample type. In both PCS and RCS, the amount of carpet in the home and the frequency of bleach use had a significant effect on the composition of fungal communities. Semi-volatile organic compounds (SVOCs) of potential human health concern, were commonly detected in the homes. Organophosphates and phthalates were recovered at a similar frequency in both PCS and RCS. Measured SVOC concentration levels were consistent with previous indoor studies although differences were observed between PCS and RCS for several SVOCs. This study demonstrates the potential and challenges associated with participant-collected dust samples for indoor environment studies.

Fractional exhaled nitric oxide (FeNO) and respiratory symptoms in junior high school students in Penang, Malaysia: the role of household exposure

We studied associations between fractional exhaled nitric oxide (FeNO), health and household exposure among school children (N = 348) in Penang, Malaysia. Multiple logistic regression and linear mixed models were applied. Overall, 46.0% had elevated FeNO (>20 ppb) and 10.6% diagnosed asthma. Male gender (p = 0.002), parental asthma or allergy (p = 0.047), cat allergy (p = 0.009) and seafood allergy (p < 0.001), diagnosed asthma (p = 0.001), wheeze (p = 0.001), ocular symptoms (p = 0.001), rhinitis (p = 0.002) and respiratory infections (p = 0.004) were all associated with FeNO. Students exposed to ETS had lower FeNO (p = 0.05). Dampness and mould was associated with wheeze (p = 0.038), especially in wooden homes (interaction p = 0.042) and among students with elevated FeNO (interaction p = 0.024). Cat keeping increased rhinitis (p = 0.041) and respiratory infections (p = 0.008) and modified the dampness associations. In conclusion, FeNO can be associated with ocular and respiratory symptoms. Elevated FeNO, cat keeping and a wooden house can enhance the risk of wheeze when exposed to dampness and mould.

Microbial Extracellular Vesicles in Host-Microbiota Interactions

Extracellular vesicles have emerged as key players in cellular communication, influencing various physiological processes and pathophysiological progression, including digestion, immune response, and tissue repairs. Recently, a class of EVs derived from microbial communities has gained significant attention due to their pivotal role in intercellular communication and their potential as biomarkers and biotherapeutic agents. Microbial EVs are membrane-bound molecules encapsulating bioactive metabolites that modulate host physiological and pathological processes. This chapter discusses the evolving history of microbiota-produced EVs, including their discovery, characterization, current research status, and their diverse mechanisms of interaction with other microbes and hosts. This review also highlights the importance of EVs in health and disease and discusses recent research that shows promising results for the therapeutic potential of EVs.

Understanding the patterns and health impact of indoor air pollutant exposures in Bradford, UK: a study protocol

INTRODUCTION

Relative to outdoor air pollution, there is little evidence examining the composition and concentrations of indoor air pollution and its associated health impacts. The INGENIOUS project aims to provide the comprehensive understanding of indoor air pollution in UK homes.

METHODS AND ANALYSIS

'Real Home Assessment' is a cross-sectional, multimethod study within INGENIOUS. This study monitors indoor air pollutants over 2 weeks using low-cost sensors placed in three rooms in 300 Born in Bradford (BiB) households. Building audits are completed by researchers, and participants are asked to complete a home survey and a health and behaviour questionnaire, in addition to recording household activities and health symptoms on at least 1 weekday and 1 weekend day. A subsample of 150 households will receive more intensive measurements of volatile organic compound and particulate matter for 3 days. Qualitative interviews conducted with 30 participants will identify key barriers and enablers of effective ventilation practices. Outdoor air pollution is measured in 14 locations across Bradford to explore relationships between indoor and outdoor air quality. Data will be analysed to explore total concentrations of indoor air pollutants, how these vary with building characteristics, and whether they are related to health symptoms. Interviews will be analysed through content and thematic analysis.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the NHS Health Research Authority Yorkshire and the Humber (Bradford Leeds) Research Ethics Committee (22/YH/0288). We will disseminate findings using our websites, social media, publications and conferences. Data will be open access through the BiB, the Open Science Framework and the UK Data Service.

Associations of long-term fine particulate matter exposure with all-cause and cause-specific mortality: results from the ChinaHEART project

Background

The chronic effects of fine particulate matter (PM2.5) at high concentrations remains uncertain. We aimed to examine the relationship of long-term PM2.5 exposure with all-cause and the top three causes of death (cardiovascular disease [CVD], cancer, and respiratory disease), and to analyze their concentration-response functions over a wide range of concentrations.

Methods

We enrolled community residents aged 35-75 years from 2014 to 2017 from all 31 provinces of the Chinese Mainland, and followed them up until 2021. We used a long-term estimation dataset for both PM2.5 and O3 concentrations with a high spatiotemporal resolution to assess the individual exposure, and used Cox proportional hazards models to estimate the associations between PM2.5 and mortalities.

Findings

We included 1,910,923 participants, whose mean age was 55.6 ± 9.8 years and 59.4% were female. A 10 μg/m3 increment in PM2.5 exposure was associated with increased risk for all-cause death (hazard ratio 1.02 [95% confidence interval 1.012-1.028]), CVD death (1.024 [1.011-1.037]), cancer death (1.037 [1.023-1.052]), and respiratory disease death (1.083 [1.049-1.117]), respectively. Long-term PM2.5 exposure nonlinearly related with all-cause, CVD, and cancer mortalities, while linearly related with respiratory disease mortality.

Interpretation

The overall effects of long-term PM2.5 exposure on mortality in the high concentration settings are weaker than previous reports from settings of PM2.5 concentrations < 35 μg/m³. The distinct concentration-response relationships of CVD, cancer, and respiratory disease mortalities could facilitate targeted public health efforts to prevent death caused by air pollution.

Funding

The Chinese Academy of Medical Sciences Innovation Fund for Medical Science, the National High Level Hospital Clinical Research Funding, the Ministry of Finance of China and National Health Commission of China, the 111 Project from the Ministry of Education of China.

Impact of indoor environment on children's pulmonary health

INTRODUCTION

A child's living environment has a significant impact on their respiratory health, with exposure to poor indoor air quality (IAQ) contributing to potentially lifelong respiratory morbidity. These effects occur throughout childhood, from the antenatal period through to adolescence. Children are particularly susceptible to the effects of environmental insults, and children living in socioeconomic deprivation globally are more likely to breathe air both indoors and outdoors, which poses an acute and long-term risk to their health. Adult respiratory health is, at least in part, determined by exposures and respiratory system development in childhood, starting in utero.

AREAS COVERED

This narrative review will discuss, from a global perspective, what contributes to poor IAQ in the child's home and school environment and the impact that indoor air pollution exposure has on respiratory health throughout the different stages of childhood.

EXPERT OPINION

All children have the right to a living and educational environment without the threat of pollution affecting their health. Action is needed at multiple levels to address this pressing issue to improve lifelong respiratory health. Such action should incorporate a child's rights-based approach, empowering children, and their families, to have access to clean air to breathe in their living environment.

Practical multidisciplinary framework for the assessment and management of patients with unexplained chronic aerodigestive symptoms

OBJECTIVE

Patients experiencing unexplained chronic throat symptoms (UCTS) are frequently referred to gastroenterology and otolaryngology outpatient departments for investigation. Often despite extensive investigations, an identifiable structural abnormality to account for the symptoms is not found. The objective of this article is to provide a concise appraisal of the evidence-base for current approaches to the assessment and management of UCTS, their clinical outcomes, and related healthcare utilisation.

DESIGN

This multidisciplinary review critically examines the current understanding of aetiological theories and pathophysiological drivers in UCTS and summarises the evidence base underpinning various diagnostic and management approaches.

RESULTS

The evidence gathered from the review suggests that single-specialty approaches to UCTS inadequately capture the substantial heterogeneity and pervasive overlaps among clinical features and biopsychosocial factors and suggests a more unified approach is needed.

CONCLUSION

Drawing on contemporary insights from the gastrointestinal literature for disorders of gut-brain interaction, this article proposes a refreshed interdisciplinary approach characterised by a positive diagnosis framework and patient-centred therapeutic model. The overarching aim of this approach is to improve patient outcomes and foster collaborative research efforts.

Nepalese indoor cookstove smoke extracts alter human airway epithelial gene expression, DNA methylation and hydroxymethylation

Household air pollution caused by inefficient cooking practices causes 4 million deaths a year worldwide. In Nepal, 86% of the rural population use solid fuels for cooking. Over 25% of premature deaths associated with air pollution are respiratory in nature. Here we aimed to identify molecular signatures of different cookstove and fuel type exposures in human airway epithelial cells, to understand the mechanisms mediating cook stove smoke induced lung disease. Primary human airway epithelial cells in submerged culture were exposed to traditional cook stove (TCS), improved cook stove (ICS) and liquefied petroleum gas (LPG) stove smoke extracts. Changes to gene expression, DNA methylation and hydroxymethylation were measured by bulk RNA sequencing and HumanMethylationEPIC BeadChip following oxidative bisulphite conversion, respectively. TCS smoke extract alone reproducibly caused changes in the expression of 52 genes enriched for oxidative stress pathways. TCS, ICS and LPG smoke extract exposures were associated with distinct changes to DNA methylation and hydroxymethylation. A subset of TCS induced genes were associated with differentially methylated and/or hydroxymethylated CpGs sites, and enriched for the ferroptosis pathway and the upstream regulator NFE2L2. DNA methylation and hydroxymethylation changes not associated with a concurrent change in gene expression, were linked to biological processes and molecular pathways important to airway health, including neutrophil function, transforming growth factor beta signalling, GTPase activity, and cell junction organisation. Our data identified differential impacts of TCS, ICS and LPG cook stove smoke on the human airway epithelium transcriptome, DNA methylome and hydroxymethylome and provide further insight into the association between indoor air pollution exposure and chronic lung disease mechanisms.

Targeting biophysical microenvironment for improved treatment of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is responsible for high disability rates, high death rates, and significant cost to health systems. Growing evidence in recent decades shows significant biophysical microenvironment changes in COPD, impacting lung tissues, cells, and treatment response. Furthermore, such biophysical changes have shown great potential as novel targets for improved therapeutic strategy of COPD, where both pharmacological and non-pharmacological therapies focusing on repairing the biophysical microenvironment of the lung have emerged. We present the first comprehensive review of four distinct biophysical hallmarks [i.e., extracellular matrix (ECM) microarchitecture, stiffness, fluid shear stress, and mechanical stretch] in COPD, the possible involvement of pathological changes, possible effects, and correlated in vitro models and sum up the emerging COPD treatments targeting these biophysical hallmarks.

Determinants of tuberculosis: an example of high tuberculosis burden in the Saharia tribe

Tuberculosis (TB) is a significant public health problem among the Saharia community, an underprivileged tribal group in the west-central part of India. There are several challenges for India's TB control program to curtail TB in the Saharia tribe. Malnutrition, poor health sector facilities, lower socio-economic status, and substance abuse are interconnected and synergistic factors contributing to a high burden of TB in the Saharia tribe. In this review, efforts are made to collate the findings of previous studies discussing the causes of high burden of TB in the Saharia tribe, social gaps for mitigating these preventable risk factors of TB in the Saharia tribe, and the plausible solutions for closing these gaps. The concept of Health in All Policies and intersectoral co-ordination is needed for the reduction of TB in the Saharia tribe and to make India TB-free by the year 2025.

Ambient Anthropogenic Carbons and Pediatric Respiratory Infections: A Case-Crossover Analysis in the Megacity Beijing

Carbon loading in airway cells has shown to worsen function of antimicrobial peptides, permitting increased survival of pathogens in the respiratory tract; however, data on the impacts of carbon particles on childhood acute respiratory infection (ARI) is limited. We assembled daily health data on outpatient visits for ARI (bronchitis, pneumonia, and total upper respiratory infection [TURI]) in children aged 0-14 years between 2015 and 2019 in Beijing, China. Anthropogenic carbons, including black carbon (BC) and its emission sources, and wood smoke particles (delta carbon, ultra-violet absorbing particulate matter, and brown carbon) were continuously monitored. Using a time-stratified case-crossover approach, conditional logistic regression was performed to derive risk estimates for each outcome. A total of 856,899 children were included, and a wide range of daily carbon particle concentrations was observed, with large variations for BC (0.36-20.44) and delta carbon (0.48-57.66 μg/m3). Exposure to these particles were independently associated with ARI, with nearly linear exposure-response relationships. Interquartile range increases in concentrations of BC and delta carbon over prior 0-8 days, we observed elevation of the odd ratio of bronchitis by 1.201 (95% confidence interval, 1.180, 1.221) and 1.048 (95% CI, 1.039, 1.057), respectively. Stronger association was observed for BC from traffic sources, which increased the odd ratio of bronchitis by 1.298 (95% CI, 1.273, 1.324). Carbon particles were also associated with elevated risks of pneumonia and TURI, and subgroup analyses indicated greater risks among children older than 6 years. Our findings suggested that anthropogenic carbons in metropolitan areas may pose a significant threat to clinical manifestations of respiratory infections in vulnerable populations.

Housing instability and cardiometabolic health in the United States: a narrative review of the literature

Housing instability is variably defined but generally encompasses difficulty paying rent, living in poor or overcrowded conditions, moving frequently, or spending the majority of household income on housing costs. While there is strong evidence that people experiencing homelessness (i.e., lack of regular housing) are at increased risk for cardiovascular disease, obesity, and diabetes, less is known about housing instability and health. We synthesized evidence from 42 original research studies conducted in the United States examining the association of housing instability and cardiometabolic health conditions of overweight/obesity, hypertension, diabetes, and cardiovascular disease. The included studies varied widely in their definitions and methods of measuring housing instability, but all exposure variables were related to housing cost burden, frequency of moves, living in poor or overcrowded conditions, or experiencing eviction or foreclosure, measured at either the individual household level or at a population level. We also included studies examining the impact of receipt of government rental assistance, which serves as a marker of housing instability given that its purpose is to provide affordable housing for low-income households. Overall, we found mixed but generally adverse associations between housing instability and cardiometabolic health, including higher prevalence of overweight/obesity, hypertension, diabetes, and cardiovascular disease; worse hypertension and diabetes control; and higher acute health care utilization among those with diabetes and cardiovascular disease. We propose a conceptual framework for pathways linking housing instability and cardiometabolic disease that could be targeted in future research and housing policies or programs.

Spatial patterns and spatially-varying factors associated with childhood acute respiratory infection: data from Ethiopian demographic and health surveys (2005, 2011, and 2016)

BACKGROUND

In Ethiopia, acute respiratory infections (ARIs) are a leading cause of morbidity and mortality among children under five years. Geographically linked data analysis using nationally representative data is crucial to map spatial patterns of ARIs and identify spatially-varying factors of ARI. Therefore, this study aimed to investigate spatial patterns and spatially-varying factors of ARI in Ethiopia.

METHODS

Secondary data from the Ethiopian Demographic Health Survey (EDHS) of 2005, 2011, and 2016 were used. Kuldorff's spatial scan statistic using the Bernoulli model was used to identify spatial clusters with high or low ARI. Hot spot analysis was conducted using Getis-OrdGi statistics. Eigenvector spatial filtering regression model was carried out to identify spatial predictors of ARI.

RESULTS

Acute respiratory infection spatially clustered in 2011 and 2016 surveys year (Moran's I:-0.011621-0.334486). The magnitude of ARI decreased from 12.6% (95%, CI: 0.113-0.138) in 2005 to 6.6% (95% CI: 0.055-0.077) in 2016. Across the three surveys, clusters with a high prevalence of ARI were observed in the North part of Ethiopia. The spatial regression analysis revealed that the spatial patterns of ARI was significantly associated with using biomass fuel for cooking and children not initiating breastfeeding within 1-hour of birth. This correlation is strong in the Northern and some areas in the Western part of the country.

CONCLUSION

Overall there has been a considerable decrease in ARI, but this decline in ARI varied in some regions and districts between surveys. Biomass fuel and early initiation of breastfeeding were independent predictors of ARI. There is a need to prioritize children living in regions and districts with high ARI.

Monitoring PM2.5 at a Large Shopping Mall: A Case Study in Macao

Employees work long hours in an environment where the ambient air quality is poor, directly affecting their work efficiency. The concentration of particulate matters (PM) produced by the interior renovation of shopping malls has not received particular attention in Macao. Therefore, this study will investigate the indoor air quality (IAQ), in particular of PM2.5, in large-scale shopping mall renovation projects. This study collected on-site PM data with low-cost portable monitoring equipment placed temporarily at specific locations to examine whether the current control measures are appropriate and propose some improvements. Prior to this study, there were no measures being implemented, and on-site monitoring to assess the levels of PM2.5 concentrations was non-existent. The results show the highest level of PM2.5 recorded in this study was 559.00 μg/m3. Moreover, this study may provide a reference for decision-makers, management, construction teams, design consultant teams, and renovation teams of large-scale projects. In addition, the monitoring of IAQ can ensure a comfortable environment for employees and customers. This study concluded that the levels of PM2.5 concentration have no correlation with the number of on-site workers, but rather were largely influenced by the processes being performed on-site.

Determinants Analysis Regarding Household Chemical Indoor Pollution

Indoor household pollution is not yet sufficiently studied in the general population. Over 4 million people die prematurely every year due to air pollution in households. This study aimed to propose quantitative data research through the administration of a KAP (Knowledge, Attitudes, and Practices) Survey Questionnaire. This cross-sectional study administered questionnaires to adults from the metropolitan city of Naples (Italy). Three Multiple Linear Regression Analyses (MLRA) were developed, including Knowledge, Attitudes, and Behavior regarding household chemical air pollution and the related risks. One thousand six hundred seventy subjects received a questionnaire to be filled out and collected anonymously. The mean age of the sample was 44.68 years, ranging from 21-78 years. Most of the people interviewed (76.13%) had good attitudes toward house cleaning, and 56.69% stated paying attention to cleaning products. Results of the regression analysis indicated that positive attitudes were significantly higher among subjects who graduated, with older age, male and non-smokers, but they were correlated with lower knowledge. In conclusion, a behavioral and attitudinal program targeted those with knowledge, such as younger subjects with high educational levels, but do not engage in correct practices towards household indoor chemical pollution.

Monitoring indoor air quality using smart integrated gas sensor module (IGSM) for improving health in COPD patients

Technology advancement, industrialisation, and globalisation have been significant reasons for air pollution outdoors and indoors. It may surprise us that we spend about 80% of our time indoors breathing toxic, stale, polluted air, making us sluggish and fretful. In contrast to outdoor air, indoor air does not recycle consistently. It traps and builds pollutants from wood and coal stoves, furniture and building materials, paints and solvents, cigarette smoke, and cleaning supplies. The prolonged exposure to these hidden pollutants can prompt respiratory disorders such as lung disease, pneumonitis, asthma, pulmonary hypertension, and chronic obstructive pulmonary disease (COPD). It is enduring and is not curable, which has been a threat to humanity for ages. COPD's major cause is airborne particulate matter and other toxic compounds emitted from indoor and outdoor sources. Outdoor air pollution can be controlled only by acquiring changes in the vast population, wherein for indoor, every individual may create a major impact on improving air purity, thereby promoting health. The proposed design model for monitoring indoor air quality was tested in a normal and stimulating environment where we live. Parameters tested included temperature, humidity, amount of PM2.5, and the concentration of CO, CO₂, and NH₃. These parameters were monitored for five to 6 h per day for 8 days. Results indicate that the total air quality lies in the moderate range. Further study will be helpful to utilise this module as an effective Indoor air quality (IAQ) monitoring system. HIGHLIGHTS: • A simple, effective, inexpensive integrated gas sensor module (IGSM) has been proposed in this study to monitor the indoor air quality index (IAQI). • Indoor air quality was tested in a normal and stimulating environment for 8 days. • The integrated gas sensor module (IGSM) was composed of sensors in series, and the outputs for the respective parameter were measured easily. • Among the parameters tested, CO and PM2.5 lie in the moderate range, while other pollutants within the normal range reveal that the tested air quality is moderate.

Merging citizen science with epidemiology: design of a prospective feasibility study of health events and air pollution in Cologne, Germany

BACKGROUND

Citizen science as an approach to merge society and science is not a new paradigm. Yet it is not common in public health, epidemiology, or medical sciences. SMARAGD (Sensors for Measuring Aerosols and ReActive Gases to Deduce health effects) assesses air pollution at participants' homes or workplaces in Cologne, Germany, as feasibility study with a citizen science approach. Personal exposure to air pollutants is difficult to study, because the distribution of pollutants is heterogeneous, especially in urban areas. Targeted data collection allows to establish connections between air pollutant concentration and the health of the study population. Air pollution is among the most urgent health risks worldwide. Yet links of individualized pollution levels and respiratory infections remain to be validated, which also applies for the feasibility of the citizen science approach for epidemiological studies.

METHODS

We co-designed a prospective feasibility study with two groups of volunteers from Cologne, Germany. These citizen scientists and researchers determined that low-cost air-quality sensors (hereafter low-cost sensors) were to be mounted at participants' homes/workplaces to acquire stationary data. The advantage of deploying low-cost sensors is the achievable physical proximity to the participants providing health data. Recruitment started in March 2021 and is currently ongoing (as of 09/22). Sensor units specifically developed for this study using commercially available electronic sensor components will measure particulate matter and trace gases such as ozone, nitrogen oxides, and carbon monoxide. Health data are collected using the eResearch system "Prospective Management and Monitoring-App" (PIA). Due to the ongoing SARS-CoV-2 pandemic, we also focus on COVID-19 as respiratory infection.

DISCUSSION

Citizen science offers many benefits for science in general but also for epidemiological studies. It provides scientific information to society, enables scientific thinking in critical discourses, can counter anti-scientific ideologies, and takes into account the interests of society. However, it poses many challenges, as it requires extensive resources from researchers and society and can raise concerns regarding data protection and methodological challenges such as selection bias.

[Asthma management and asthma control level in children]

OBJECTIVES

To investigate the influencing factors for asthma management and asthma control level in children.

METHODS

A total of 202 children with a confirmed diagnosis of asthma were enrolled. The questionnaire of asthma control level and family management was used to investigate the influencing factors for asthma control level and the indicators of family management. The awareness of childhood asthma and its management was analyzed among the parents, as well as the influence on asthma control level in children, and the association between them was analyzed.

RESULTS

Compared with the non-complete control group, the complete control group had significantly longer course of asthma and treatment time (P<0.05). The proportions of asthma attacks ≥3 times and aerosol treatment for asthma attacks >3 times in one year in the complete control group were significantly lower than those in the non-complete control group (P<0.05). The complete control group had a significantly lower proportion of children with frequent respiratory infection, wheezing during respiratory infection, or a family history of allergic diseases (P<0.05). The parents in the complete control group had significantly stronger awareness of short-term escalation to asthma medication after respiratory infection and significantly enhanced management of maintenance medication (P<0.05). Compared with the complete control group, the non-complete control group had a significantly higher proportion of children with abnormal pulmonary function at the initial stage (P<0.05). The level of asthma control in children was associated with short-term escalation to asthma medication during respiratory infection and initial lung function (P<0.05).

CONCLUSIONS

The level of asthma control in children is closely associated with the severity of asthma and the comprehensive management of childhood asthma. Early treatment and family management, especially escalation to asthma medication during the early stage of respiratory infection, are of great importance in asthma control. Citation:Chinese Journal of Contemporary Pediatrics, 2023, 25(1): 73-79.

Respiratory Diseases' Burden in children and adolescents of marginalized population: A retrospective study in slum area of Karachi, Pakistan

Background

Worldwide, the burden of respiratory disease has dramatically increased, endangering public health. To our knowledge, there have been no reported cases of respiratory illness among children and adolescents living in the slums of Karachi, Pakistan. This study aimed to assess the burden of respiratory disease in marginalized slum populations and the factors causing such an increase in disease burden.

Methods

This study was conducted in 35 slums of Karachi, Pakistan, to determine the prevalence of respiratory disease in children and adolescents. Data on pneumonia, bronchitis, bronchiolitis, tuberculosis, and asthma from August 2019 to July 2022 were analyzed and inferences were drawn.

Results

Among the studied diseases, pneumonia was more prevalent among females (39,864, 44.9%), followed by males (19,006, 21.4%). Most of the children (59,988, 67.6%) were aged 1-5 years. In addition, of those diagnosed with pneumonia, 50,348 (56.8%) were from the same age group. Furthermore, bronchiolitis was found among 10,830 (12.2%) children aged 5-9 years. The majority (46,906, 52.9%) of the studied population belonged to the Pathan ethnicity, followed by Sindhi (21,522, 24.2%), and most of them (84,330, 95.1%) were of a lower socioeconomic status.

Conclusions

This study found that pneumonia is the most common respiratory disease followed by bronchiolitis in children and adolescents in a marginalized slum population of Karachi, Pakistan. Both pneumonia and bronchiolitis have seasonal variations in their occurrence.

Biomass using tribal women exhibited respiratory symptoms, hypertensive risks and abnormal pulmonary function

In rural areas of developing countries, solid fuels are still widely used for cooking, heating, and lighting purposes. This study investigates the effects of household air pollutants (HAPs) exposure on the occurrence of respiratory symptoms, blood pressure, and lung function. In this study, we randomly selected 123 (83 biomass and 40 clean fuel user) subjects to assess the impact of smoke generated from solid biomass fuel by assessing their health status along with the ventilation pattern of the kitchens and living rooms. HAPs (PM10, PM2.5, and CO) and different health parameters were measured along with monitoring of self-reported health symptoms for a consecutive period of eight months. Results revealed that the concentration of CO, PM2.5, and PM10 were found highest in biomass using households. Higher odds of the upper respiratory symptoms, runny nose (OR: 4.08, 95% CI: 1.22-22.14, p < 0.03), nasal congestion (OR: 9.07, 95% CI: 1.39-97.89, p < 0.01) and the odds of the lower respiratory symptoms like wheezing (OR: 1.62, 95% CI: 1.23-10.94, p < 0.01), breathlessness (OR: 4.44, 95% CI: 1.3-14.75, p < 0.01), chest tightness (OR: 4.89, 95% CI: 1.23-22.14, p < 0.03) and dry cough (OR: 3.661, 95% CI: 1.05-12.25, p < 0.04) were significantly higher in biomass fuel user. Similarly higher systolic (+11.41 mmHg), higher diastolic pressure (+3.3 mmHg), higher pulse pressure (+8.11 mmHg), and a 6 mmHg higher mean arterial pressure among biomass fuel using tribal women. The risk of hypertension was significantly (p < 0.03) higher (OR: 3.04; 95% CI: 1.18-7.89) among solid biomass fuel users. The lung abnormality was recorded 28.91% (OR: 5.02, 95% CI: 1.50 to 16.56, p < 0.01) among biomass fuel user. Finally, it is suggested that the use of efficient cookstoves, increase in cross ventilation, and cleaner fuel are urgently needed to curb the pollution load.

Effect of preconceptional, prenatal and postnatal exposure to home environmental factors on childhood pneumonia: A key role in early life exposure

BACKGROUND

Increasing evidence have associated pneumonia with early exposure to ambient air pollution. However, the role of indoor environmental factors exposure in early life on childhood pneumonia remains unclear.

OBJECTIVE

To examine the association between indoor environmental factors exposure during different timing windows and childhood pneumonia, and to identify the key indoor factor(s) in different critical window(s).

METHODS

A retrospective cohort study of 8689 pre-schoolers was performed in Changsha, China during 2019-2020. Our questionnaire survey was designed to collect information on pre-schooler's outcome and residential environmental exposure containing indoor pollution and allergens during 1 year before pregnancy, pregnancy, first year, and past year. The associations were further estimated stratified by personal exposure level of outdoor NO₂, CO, temperature (T) and different covariates. Associations were assessed by multiple logistic regression model in terms of odds ratio (OR) of 95% confidence interval (CI).

RESULTS

Pre-schooler's pneumonia was significantly related with exposure of new furniture, redecoration, mold/damp stains, and mold or damp clothing or bedding exposure during the four periods, with the strongest associations observed during 1 year before pregnancy based on multi-window model, with ORs (95% CI) of 1.27 (1.12-1.44), 1.26 (1.09-1.46), 1.34 (1.14-1.57), and 1.28 (1.05-1.56) respectively. Environmental tobacco smoke (ETS) including both parental and grandparental smoking were significantly related with increased risk of pre-schooler's pneumonia, and ETS played a more important role in early life, with ORs (95% CI) of 1.17 (1.01-1.36) and 1.19 (1.02-1.39) in pregnancy and first year. Indoor plants particularly nonflowering plants significantly elevated pneumonia risk but only in past year, with ORs (95% CI) of 1.17 (1.05-1.30) and 1.14 (1.03-1.26). Higher pneumonia risk was observed for renovation exposure in pre-birth compared to post-birth, while mold/dampness exerted an accumulative effect with the highest risk for exposure during both pre- and post-birth. Living near traffic road and exposure to high level of traffic-related air pollution and high temperature significantly increased pneumonia risk. Sensitivity analysis found that some sub-groups were more susceptible to pneumonia risk of home environment exposure.

CONCLUSION

Early life exposure to indoor environmental factors plays an important role in pneumonia development, supporting the hypothesis of "Preconceptional and Fetal Origin of Childhood Pneumonia" and "Developmental Origins of Health and Pneumonia".